Teaspoon of sodium bicarbonate all it takes to manage biopsy pain

Adding a small amount of sodium to the local anesthetic used in image-guided breast biopsies can significantly reduce injection pain, according to an article published in the Journal of the American College of Radiology.

Patient satisfaction will likely influence reimbursement in the new value-based paradigm. Surveys like the Hospital Consumer Assessment of Healthcare Providers and Systems dedicate 30 percent of questions to patient satisfaction, including pain management. It falls to the radiology department to properly mitigate pain during an image-guided procedure—something that just takes a little sodium, in this case.

The number of breast biopsies preformed in the US grew about five percent annually from 1997 to 2008, largely as a function of increased mammography utilization, according to a study published in Radiology. While there are ever-present fears of overdiagnosis in the mammography community, growth in the number of biopsies wasn’t rampant, according to Kwan et al.

Lidocaine hydrochloride is commonly used as a local anesthetic for the procedure, but the injection can cause a temporary intensifying of pain due to its acidic pH. Studies have shown sodium bicarbonate is useful for minimizing injection pain in IVs, but there was a lack of data on its effectiveness in breast biopsies, according to lead author and internal medicine resident Alison Vasan, MD, JD, of the Duke University School of Medicine.

Vasan and her co-authors sorted 85 women undergoing core needle biopsy into two groups, one receiving injections with sodium and the other receiving injections with just lidocaine. While women receiving superficial injections reported less pain with the sodium than without, it wasn’t statically significant because of the small sample size, said Vasan and colleagues.

However, women receiving deeper intraparenchymal injections reported significantly less pain when the sodium was added to the injection, crossing the threshold of statistical significance.

In light of these results, Vasan et al recommend the practice of adding sodium bicarbonate to everyday clinical workflows.

“The smallest and least expensive five-mL vial of sodium bicarbonate provided ample volume for buffering lidocaine for both intradermal and intraparenchymal injections, and patients reported no negative effects from buffered lidocaine used during breast biopsies,” the authors wrote. “In clinical practice, minimal additional time is required to draw up the sodium bicarbonate, and the cost is low.”

If cost or time is an issue, practices could limit adding sodium to intraparenchymal injections, ultrasound-guided biopsies, and patients with scattered density or preprocedural breast pain.

“Women with preprocedural breast pain experienced significantly less pain during intradermal injection when lidocaine was buffered with sodium bicarbonate compared with lidocaine alone, suggesting that buffered lidocaine for intradermal injections may be more helpful for patients reporting preprocedural breast pain,” wrote Vasan et al.

Adding sodium bicarbonate to lidocaine injections is a cost-effective way to improve the patient experience, a metric that will increasingly affect reimbursement going forward. Imaging departments would be wise to take note—after all, five mL of sodium bicarbonate costs about $10, a small price to pay for happy patients.